Healthcare Provider Details

I. General information

NPI: 1093750036
Provider Name (Legal Business Name): MARY COLE-CERRONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/07/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD SUITE 202
HUNTINGDON VALLEY PA
19006-6357
US

IV. Provider business mailing address

727 WELSH RD SUITE 202
HUNTINGDON VALLEY PA
19006-6357
US

V. Phone/Fax

Practice location:
  • Phone: 215-914-2119
  • Fax: 215-914-1663
Mailing address:
  • Phone: 215-914-2119
  • Fax: 215-914-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW02806
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCW012806
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: